AGREE

AGREE
The AGREE Collaboration. Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument.

Burgers J, Fervers B, Haugh M. 'Guideline appraisal ? an international viewpoint' February 2004.
[External Link]

AGREE is the acronym for "Appraisal of Guidelines Research and Evaluation". The purpose of the AGREE Instrument is

• To provide a systematic framework for appraising the quality of clinical guidelines
• To help policymakers decide which guideline to recommend for use in practice
• To help guideline developers follow a structured and rigorous methodology
• To help health care providers assess guidelines before adopting recommendations in practice

The AGREE Instrument consists of 23 key items organized in six domains. Each domain is intended to capture a separate dimension of guideline quality.

Six Domains

1. Scope and purpose (items 1-3) is concerned with;
   • the overall aim of the guideline
   • the specific clinical questions
   • the target patient population
2. Stakeholder involvement (items 4-7)
   • includes individuals from all relevant professional groups
   • patient's vies and preferences have been sought
   • target users are clearly defined
   • guidelines has been piloted among target users
3. Rigour of development (items 8-14)
   • systematic methods were used to search for evidence
   • the criteria for selecting the evidence are clearly described
   • the methods used for formulating the recommendations are clearly described
   • the health benefits, side effects and risks have been considered in formulating the recommendations
   • there is an explicit link between the recommendations and the supporting evidence
   • the guideline has been externally reviewed by an expert panel prior to publication
   • a procedure for updating the guideline is provided
4. Clarity and presentation (items 15-18)
   • the recommendations are specific and unambiguous
   • the different options for management of the conditions are clearly presented
   • key recommendations are easily identifiable
   • the guideline is supported with tools for application
5. Applicability (items 19-21)
   • the potential organizational barriers in applying the guideline have been discussed
   • the potential costs implications of applying the recommendations have beed considered
   • the guideline presents key review criteria for monitoring and/or audit purposes
6. Editorial Independence (items 22-23)
   • the guidelines is editorially independent from the funding body
   • conflicts of interest of guideline development members have been recorded

Response Scale

Each item is then rated on a 4-point scale from "Strongly Agree to Strongly Disagree" depending upon the extent to which an item has been fulfilled.

Calculations

Standardized guideline domain scores are calculated by:

• summing up all the scores of individual items in a domain
• and by standardizing the total as a percentage of the maximum possible score for that domain

Example:

Max. possible score = 4 (strongly agree) × 3 (items) × 4 (appraisers) = 48
Min. possible score = 1 (strongly disagree) × 3 (items) × 4 (appraisers) = 12

The standardized domain score will be:

(score possible min. - score possible max.) / (score possible min. - score obtained)
= (36 - 12) / (48 - 12)
= 24 / 36
= 0.67 × 100
= 67%